Unmatched: Starting a preliminary internship vs. Doing more student rotations

[khamr0n]

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I did not match in PM&R last year and had to decide between starting my internship and delaying graduation to do more student rotations. I wanted to do more student rotations, but the majority of advice I received suggested that I start internship and continue to look for openings. Regardless of all that, I have started my Preliminary year in Internal Medicine, and am starting to feel like I made the wrong decision. I have applied for two 2008 openings but have not heard back from either of them, and am now also applying for 2009 positions through the match. I think programs will be concerned about accepting someone who is going to have an entire year between his internship and pgy2 year: my plan is to do research and try to find some sort of inpatient work to remain clinically adept, but I don't know how effective that will be.

I would honestly be enjoying my internship if it I didn't have this constant preoccupation with securing a PM&R position for the future. I have thought about it long and hard, and I do not want to compromise for another field, and I am definitely pursuing physiatry for the right reasons. Does anyone have any advice on how I should go about securing a spot and presenting myself this time around? Also, any thoughts about how to spend that potential year in between pgy1 and pgy2 productively?

 

[PMR 4 MSK]

The first thing is an honest look at why you didn't match - was it grades or board scores? Did you not interview well? Did you apply to and/or interview at too few programs. With that information we could give you a more focused answer.

If you haven't already, call those 2008 programs and talk to their residency director. Ask for a face-to-face interview or an honest opinion of your chances. Find out if there are any other programs that haven't filled and call them too. Try and find out if there is a way to be notified if any positions open up anywhere (at my program, an incoming resident got fired during internship, but they found a replacement).

Talk to local physiatrists and see if they have any connections with their residency programs or anyone currently. Same thing with the physiatrists at your med school or those you rotated with. Find anyone from a previous class at your med school who went into PM&R and see if they have any contacts.

As for the in-between year, maybe you can consider going into practice. Not sure if you still can, but you used to be able to do general practice with just a license after internship. Maybe you could consider a city's free clinic, a VA or a rural health care clinic. Maybe you could consider joining a volunteer organization that goes to foreign countries for some real-world experience.

Otherwise, maybe you could do a second internship (shudder!) such as a transitional year. There are often programs that didn't fill or lose people and just want a warm body in that position - they get paid to educate you. same thing for a second-year program (but less likely).

 

[topwise]

See, this is why I'm confused... there's another thread about how nobody wants to do PM&R and how all the spots end up getting filled with FMGs. But clearly the PM&R spots must be desirable if students are going unmatched.

I think you made the right decision by starting your prelim year. It's still really early in the year and you never know when a spot will open up for 2008... I think you have a really good shot at it (although I admittedly don't know anything about you). Plus if you finish an intern year, you can get a medical license and do some moonlighting next year if you don't find a residency spot.

If you don't get the PM&R spot for 2008, I think research is the way to go with maybe some moonlighting for extra money.

 

[Disciple]

See, this is why I'm confused... there's another thread about how nobody wants to do PM&R and how all the spots end up getting filled with FMGs. But clearly the PM&R spots must be desirable if students are going unmatched.

PM&R has increased in competitiveness since the late 80's and through the 90's. However, there are still limited numbers of medical students in the know (poor marketing on our part), and the field itself is still relatively obscure. Myself, as well as others on this board I'm sure, found out about this field by accident.

Should the AAPMR go an an agressive marketing campaign focused on exposing medical students to Physiatry early in their training, I think you would see the desireability of the field amongst US grads increase dramatically.

We do the med student informational program at the AAPMR each year, which is not the best approach in my opinion (you're marketing to students who are already interested in PM&R, that's why they're at the AAPMR meeting).

A better approach would be for each residency program to give a casual yet informative talk on PM&R for 2nd year med students each spring at the corresponding medical school , followed by encouraging the formation of PM&R med-student interest groups specifically targeting underclassmen.

 

[axm397]

We do the med student informational program at the AAPMR each year, which is not the best approach in my opinion (you're marketing to students who are already interested in PM&R, that's why they're at the AAPMR meeting).

A better approach would be for each residency program to give a casual yet informative talk on PM&R for 2nd year med students each spring at the corresponding medical school , followed by encouraging the formation of PM&R med-student interest groups specifically targeting underclassmen.

I agree that the 2nd approach is more "grassroots" and may be better - BUT, we do advertise the AAPM&R med student program to non AAPM&R members via the AMSA listserve. We also contact all the medical schools and residency programs in the area each year to try to get a "buzz" going. There are some med students who were already intersted in PM&R and registered for the assembly but each year there are MS1s and 2s who didn't know about PM&R who come to the free half day program.

This year's timing wasn't the best - probably too early in the year - but we still had about 50 students show up. The one in Philly drew about 140 students and many of them were MS1s and 2s.

The membership committee who sponsored the event this year is really committed to the cause. Even if we are only successful in recruiting ONE high quality medical student to the field, it is worth it in their opinion. Of course, I have more ambition than that.

 

[ampaphb]

I really don't know the answer to this, so am curious - are we better off focusing our efforts to the widest possible audience? (ie all med students through AMSA)

Or if actual knowledge that the field exists, and what we do, is critical, might our efforts be better focused on med schools institutions where there AREN'T PM&R residencies, and where are a result, med students get NO exposure to PM&R.

I was a med student at Northwestern - as a result, it was hard to miss the big building across the street that did rehab, but I'm thinking that might not be so apparent at Duke, or Vanderbilt, or George Washington, etc.

 

[Disciple]

I don't think it needs to be "either/or".

Efforts could be focused on cities with high densities of medical students and multiple medical schools e.g. Chicago, New York, etc. and at schools without an attached PM&R residency program (e.g. residents at UNC could be asked to present at Duke and Wake Forest).

Lectures would only have to be done only once per year. If the PD can't find the time to do it, it should be delegated to the chief resident.

Interested students could sign up with contact info before or after the lecture, and from that list, a PM&R interest group could be created. At schools without an attached residency, The PM&R residency providing the lectures could assist students in finding appropriate rotation opportunities. After a few cycles of successful PM&R matches, the group would be self-sustaining.

 

[transferring08]

I'm doing my prelim year, and was accepted into a neurology position for 2008, but I want to switch to PM&R. I want to start in 2008, but don't even know where to look to see who's accepting applications for 2008. Where do I look? Do I have to go through ERAS again, or do I email residency directors, or....? Please help! I know it's super late in the application process, but I really want to apply this year. Thanks,


khamr0n
I have applied for two 2008 openings but have not heard back from either of them, and am now also applying for 2009 positions through the match.

 

[topwise]

I'm doing my prelim year, and was accepted into a neurology position for 2008, but I want to switch to PM&R. I want to start in 2008, but don't even know where to look to see who's accepting applications for 2008. Where do I look? Do I have to go through ERAS again, or do I email residency directors, or....? Please help! I know it's super late in the application process, but I really want to apply this year. Thanks,

Look on Freida for PM&R programs, then start calling the residency coordinators one by one to see if there are spots available. That's what I did. It depends on the program, but I don't think you should have to go through ERAS to get a spot for next year. Also, as the year goes on, residents may "drop out" of their positions for next year (as you are planning to do with your neuro position) so more spots may open up... and as it gets closer to July, the program directors are going to be more eager to fill those spots.

 

[khamr0n]

thanks for the replies...I will keep looking: as far as my application- I was not very competitive during medical school. I have always enjoyed learning and developing my clinical skils, but never spent enough time mastering the material well enough to score high on final exams and the USMLEs. I guess I'm really paying for it now- I think my application basically gets screened out because of below-average scores...the reason I regret not doing more rotations is because now I don't have a way of breaking through that bad first impression that my low scores give.

As far as the other discussion- I agree that medical student awareness of the field is important, but even more important is the general population's awareness of PM&R's approach to patient care. It seems like we always get the patients that have been seen by a variety of other specialists before they end up seeing physiatrists for restorative treatment. If our referrals were based on trying to prevent conditions from progressing to the point that they need drastic medical intervention, there is a tremendous potential for increased cost effectiveness as well as improved patient satisfaction. I think that Physiatrists value overall quality of life for patients more than any other single field, and we are unfortunately somewhat limited to patients who are afflicted with impairments- why not extend that same service to patients who are on their way to having impairments? Increased public awareness will automatically lead to increased med student awareness- the spotlight will naturally fall on whichever field is attractive to the public.